OBJECTIVES: Brazil is among the countries with the largest dengue burden in the world. The only licensed dengue vaccine (CYD-TDV) is currently indicated specifically for individuals previously infected by dengue. In September 2018, the World Health Organization recommended pre-vaccination screening as their preferred option for dengue vaccination to minimize potential risks associated with vaccinating seronegative individuals and ensure vaccination benefits for seropositive individuals. Screening tests should have high sensitivity to accurately detect seropositive persons and high specificity to avoid vaccinating seronegative persons. Based on a dynamic dengue transmission model, we aim to assess the potential public health impact and efficiency of a public vaccination program in a high endemic region of Brazil (Northeast) for different profiles of the screening test. METHODS: The age-structured compartmental model was calibrated with local epidemiological data. The health impact of routine dengue vaccination at 12 years old with a catch-up program of 7 cohorts was modeled over 10 years considering pre-vaccination screening with tests of specificity of 98% and 99% and sensitivity from 50% to 90%. All tests considered translated in predictive positive value higher than 98% in Northeast. RESULTS: According to test characteristics, vaccination would reduce the number of dengue cases by 16% to 28%, severe dengue and hospitalizations by 16% to 29%. The number of subjects needed to vaccinate (NNV) to prevent a case was less than 4 for symptomatic dengue, 64 for hospitalizations and 245 for severe dengue for all tests considered. Compared with the strategy without pre-vaccination screening, NNV was reduced by 9-10% for symptomatic dengue, by 14-18% for hospitalizations, and by 17-21% for severe dengue. CONCLUSIONS: A campaign with pre-vaccination screening would not only have a significant public health impact and limit the risk for seronegative individuals but also translate into higher efficiency through a better allocation of vaccination resources.